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Introduction: Medullary carcinoma (MTC) is a rare neuroendocrine thyroid neoplasm. The international medullary thyroid carcinoma grading scheme (IMTCGS), which has prognostic significance, has been introduced recently. The present study graded MTC cases using the IMTCGS and evaluated it in our study cohort. Methods: All MTC thyroidectomy cases over 6 years were evaluated. Low-grade (LG) and high-grade (HG) were compared. Survival analysis included overall survival (OS), loco-regional free survival and distant metastasis free survival (DMFS). Results: Of 32 cases, 31.25% were HG and 68.75% LG. The mean age was 44.0 years and M:F ratio 1:1.146. HG patients were older and had tumour cells with high-grade nuclear features and prominent nucleoli and showed distant metastasis. Necrosis was found more in patients with high grade nuclear features. There was discordance between the high Ki67 (60%) and increased mitotic activity (20%). Univariate survival analysis revealed poor DMFRS and OS in the cohorts with high grade, Ki67 > 5% and coagulative necrosis. The multivariate cox regression analysis showed IMTCGS significantly associated with overall survival (HR 28.30, p = 0.009) and DMFS (HR 15.70, p = 0.02). Discussion and conclusion: This is the first Indian study evaluating IMTCGS, a very simple and convenient grading system that can be readily used in any tertiary health care centre. IHC for Ki 67 should mandatorily be done irrespective of the low mitotic activity on the HPE and necrosis should be diligently searched in cases with high-grade nuclear morphology. HG MTC cohorts were associated with poor OS as well as DMFRS. [ABSTRACT FROM AUTHOR]

Retinoblastoma, the most common primary intraocular malignant neoplasm in young children, show frequent metastasis to lymph nodes, central nervous system and bones. However, retinoblastoma metastasizing to parotid gland is very rare. We here present 2 cases of isolated parotid gland metastasis in two children with unilateral retinoblastoma. Case 1 was a one-year-old child presenting with left globe lesion which was diagnosed as Retinoblastoma. Post chemotherapy, enucleation was done which on histopathology examination showed retinoblastoma with scleral invasion and anterior chamber seeding. On 3 month follow up, patient presented with left parotid swelling. He underwent Fine needle aspiration cytology (FNAC) and Core needle biopsy which confirmed retinoblastoma metastasizing to parotid following which superficial parotidectomy was done as it was a solitary hotspot on PET-CT followed by localized radiotherapy and chemotherapy. While case 2, a 6-year-old child presented with left parotid swelling with a history of undergoing enucleation 3 months earlier in an outside hospital; Enucleation slides were reviewed in addition to patient undergoing FNAC and Biopsy from parotid swelling, all of which were consistent with Retinoblastoma metastasizing to parotid; This patient was lost to follow up; Although rare with only a few case reports in literature, both the pathologist and the clinician should be aware of retinoblastoma metastasizing to parotid, which when diagnosed and treated promptly has overall better prognosis in the cases reported so far. [ABSTRACT FROM AUTHOR]

Oral SCC (OSCC) is the eighth most prevalent cancer in the world. [1] Head and neck cancer account for more than 650,000 cases and 330,000 deaths annually worldwide. India is the world capital accounting for one-third of the global burden.[2] About 60–80% of the patients in India suffering from oral cancer are detected in the advanced stages with tongue malignancies invariably involving floor of mouth (FOM) either by primarily or forming the base of resection.[3,4] Advanced oral cavity lesions, particularly that of tongue and FOM are associated with morbidities like speech, swallowing and breathing difficulty.[5] Hence, a balance between adequate oncological margins and optimal functional outcome is a challenge. Mandibular lip-split and the pull-through are the two commonly used surgical techniques.[6-8] High recurrence rates of 30% with lip-split approach has led us to opt for a more secure radical approach.[9] Para-hyoid region zone is the most common site of early recurrence which is neither included in the dissection specimen nor accessible by trans-oral approach.[10] Therefore, the pull-through technique was devised for en-bloc resection of tongue cancers with cervical lymphatics. We aim to assess the oncological and functional of this Pull-through technique in locally advanced Tongue and FOM cancers. A retrospective observational study was done for patients operated in the institute from Jan 2021 - Jan 2023. 75 patients with locally advanced carcinoma tongue or FOM undergoing resection by pull through approach were included in the study. Surgical Technique (Image1: attachment) In this technique, the Visor approach was used and Subplatysmal skin flaps raised. Bilateral level IA/IB dissection was performed, and the suprahyoid muscles divided from their bony attachment to enter the oral cavity. Subsequently, the gingivo-labial sulcus was incised on either side carefully considering for the margins and the tongue was dropped into the neck, thereby providing access to all parts of the tongue and oropharynx. Mandibulectomy, if required, was done beforehand intraorally delivering the segment with the specimen in toto. Resection and reconstruction was then performed under direct vision. Reconstruction was done either with pedicled or free flap insertion. Reattachment of the digastric muscles or remnant genioglossus, and geniohyoid muscles on both sides with the flap was done to reconstruct the floor. [Display omitted] Post-operative Follow-Up Patients were followed up postoperatively and received adjuvant treatment as per NCCN guidelines and were provided with rehabilitatory support. Six months after the treatment, Speech, swallowing, and breathing was assessed using HNC FIT (Functional Integrity) scales.[11,12] Patient Characteristics A total of 75 patients were included in the study with 55 (73.33%) males and 20 (26.66%) females with a mean age of 47 years (range 30–76 years). Procedural parameters Out of a total of 75 patients, 3(4%) underwent total glossectomy, 11(14.66%) near total and 18(24%) anterior oblique glossectomy. 18 of the 75 patients underwent mandibular resections (6 - segmental and 12- marginal). Histopathology 19 patients had T2 lesions, 26 T3 lesions and 30 T4 primaries. 31 patients (41.3%) had node negative disease while 44 (58.6%) were node positive with 16 having positive contralateral neck nodes. 24 of 75 patients (32%) had lympho-vascular invasion while 37 (48%) had perineural invasion. Functional outcome As an institutional protocol, all patients undergoing major tongue resections were tracheostomised. The median duration of tracheostomy removal was 15th postop day (1st Follow-up) and 57(76%) patients were tracheostomy free by the completion of adjuvant treatment. However, 6(8%) patients had permanent tracheostomies. Ryle's tube feeding was started postoperatively escalating to oral feeds by POD5. Swallowing and speech rehabilitation was provided and on 6 monthly follow up, 17 of 75 (22.5%) patients tolerated solid food (HNCFIT food intake grade 3), 19 (25.3%) soft and 21 (28%) liquid diet, a total of 40 (53.3%) patients in grade 2. 9 (12%) patients required Ryle's tube due to inadequate oral intake (grade 1), while 8 (10.6%) were entirely dependent on tube feeds (grade 0). Out of 75 patients, 4 (5.3%) had no phonation (HNCFIT grade0), 8(10.5%) unclear speech (Grade1), 14(18.66%) had comprehensible speech with telephoning possible (grade 2), 44 (58.6%) had understandable speech with voice change(grade3), 5(6.66%) had normal voice (grade 4). [Display omitted] The pull-through approach had the advantages of good accessibility and functional outcome and ensures resection with adequate margins. Effective surgical treatment can contribute to the improved quality and length of survival of these patients. [ABSTRACT FROM AUTHOR]

Thyroid cancer is the most common endocrine malignancy, accounting for 1 % of all cancers 1. The genetic syndromes associated with differentiated thyroid cancers(DTC) are Cowden syndrome, Familial Adenomatous Polyposis(FAP), Carney's complex, Pendred syndrome and Werner syndrome2. The incidence of synchronous second primary tumors(SSPC) associated with oropharyngeal malignancies was 1 to 10 %3. The incidence of other malignancies other than the above syndromes occurring synchronously with DTC is very rare. Only a few case reports and series are available. The incidence of synchronous second primary cancer(SSPC) with Differentiated Thyroid Cancers(DTC) is a very rare entity. Very few case reports and case series were published in the literature. The current study is aimed to enumerate the clinicopathological data of patients with DTC with SSPC. This is a single-center retrospective study. All the patients diagnosed with DTC and SSPC from January 2016 to July 2023 were included in the study. The demographic, clinicopathological data and survival data were collected from the institute's database. Patients were followed up telephonically and survival status was documented. Synchronous cancers are defined as more than one independent primary malignancy when the second(or third) cancer occurs within six months of diagnosis of the first malignancy4. [Display omitted] A total of 1395 patients were diagnosed with thyroid cancer during the study period. Twelve patients were found to have DTC with SSPC. All the patients had papillary thyroid cancer as primary DTC. Ten patients had head and neck squamous cell carcinoma, one had malignant phyllodes tumor, and another patient with endometrioid adenocarcinoma as the SSPC. Six patients diagnosed during preoperative evaluation, one patient diagnosed 3 months after the oral malignancy diagnosis and five patients were diagnosed to have PTC in cervical nodes after neck dissection. Complete thyroid removal was done in six patients and hemithyroidectomy in two patients. Among the patients who underwent total thyroidectomy, four patients had undergone radioactive iodine scan followed by radioactive iodine ablation for two patients. Three patients had died during follow-up, two patients was lost to follow-up and the rest of the seven patients were alive. Out of those alive one patient had a follow-up of less than six months and was excluded from the survival calculation. The median follow up was 25.55 months. The median overall survival was 40.97 months. DTC constitute 95% of thyroid malignancies. Five to fifteen percent of DTC has familial disease. The genetic syndromes associated with DTC are FAP, PTEN syndromes(Cowden syndrome, Bannayan- Riley-Ruvalcaba syndrome, PTEN hamartoma tumor syndrome), Werner syndrome, Carney complex, DICER1 syndrome, Pendred syndrome, Ataxia telangiectasia, Li Fraumeni syndrome, and Peutz Jeghers syndrome5. But, synchronous occurrence of a second malignancy with DTC is a rare phenomenon. In the present study, the most common SSPC was SCC of the head and neck region(83.3%). 5 patients had incidental detection of thyroid cancer in cervical lymph nodes which were dissected during neck dissection done for other causes. L J Fliegelman et al published a paper on four cases of incidentally detected thyroid malignancy in cervical nodes6. Ansari-Lari et al also published cases of incidentally diagnosed PTC on cervical lymph nodes7. In the present study, one patient had synchronous papillary thyroid carcinoma with a malignant phyllodes tumor of the breast. No such case was found reported in the literature during our literature search. In the present study, we reported a case of synchronous endometrioid adenocarcinoma with PTC. Badan Marius-loan et al reported one case of PTC with endometrioid carcinoma8. Patients with Cowden syndrome can have thyroid carcinoma and endometrial carcinoma9. The overall survival of the study group was 40.97 months. Biopsy-proven SCC recurrence was seen in two patients out of four patients with clinically documented recurrence. In the literature review on case series and case reports, it was concluded that the prognosis of the patient depends on the staging of oral synchronous primary and the treatment of thyroid cancer must be decided based on oral malignancy staging and treatment. In conclusion SSPC with DTC is a very rare phenomenon. SCC of the head and neck region is the most common synchronous second primary malignancy associated with DTC. As there are no published guidelines for this clinical scenario, a multi-disciplinary panel discussion is a must to decide regarding management considering the staging and weighing the treatment benefit for both malignancies. [ABSTRACT FROM AUTHOR]